{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T04:09:07Z","timestamp":1793419747457,"version":"4.5.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012446","name":"Akershus University Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012446","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate whether national population-level antibiotic consumption influences antimicrobial resistance (AMR) in Norwegian Neisseria gonorrhoeae isolates. To explore metrics suitable for ecological AMR studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Longitudinal Norwegian gonococcal susceptibility data (2003\u20132024) were analysed alongside national antibiotic consumption. Temporal trends were examined graphically and associations assessed using one-tailed Spearman rank correlations. Novel metrics\u2014The \u201cSusceptible Isolate Pressure Indicator\u201d (SIPI) and \u201cWild-Type Isolate Pressure Indicator\u201d (WIPI) ratios were introduced to characterize shifts in minimum inhibitory concentration (MIC) distributions within susceptible or wild-type ranges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Strong positive, significant correlations were observed between consumption of the most widely used antibiotic classes in Norway\u2014betalactamase-sensitive penicillins and tetracyclines\u2014and gonococcal geometric mean MIC for benzylpenicillin (\u03c1 = 0.776, P &amp;lt; .001) and tetracycline (\u03c1 = 0.841, P &amp;lt; .001). Penicillin-class consumption was also significantly associated with betalactamase plasmid carriage (\u03c1 = 0.637, P = .013), consistent with horizontal gene transfer from commensal flora.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Even in a low-consumption European context, Norwegian antibiotic use appears to shape gonococcal resistance, possibly partly via gene uptake from commensal Neisseria. The SIPI and WIPI ratios describe susceptible-range MIC histogram shapes, and offer utility for AMR surveillance by capturing isolate flux.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag076","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T12:34:02Z","timestamp":1770122042000},"page":"e1193-e1202","source":"Crossref","is-referenced-by-count":1,"title":["The Influence of National Antibiotic Consumption on\n                    <i>Neisseria Gonorrhoeae<\/i>\n                    Antibiotic Resistance in Norway, 2003\u20132024"],"prefix":"10.1093","volume":"233","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8959-4161","authenticated-orcid":false,"given":"Patricia","family":"Campbell","sequence":"first","affiliation":[{"name":"Department of Microbiology and Infection Control, Akershus University Hospital , L\u00f8renskog ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"2026051419581444200_jiag076-B1","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1128\/CMR.00010-14","article-title":"Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future","volume":"27","author":"Unemo","year":"2014","journal-title":"Clin Microbiol Rev"},{"key":"2026051419581444200_jiag076-B2"},{"key":"2026051419581444200_jiag076-B3","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1146\/annurev-micro-022024-024306","article-title":"Commensal Neisseria and antimicrobial-resistant gonorrhea","volume":"79","author":"Wadsworth","year":"2025","journal-title":"Annu Rev Microbiol"},{"key":"2026051419581444200_jiag076-B4","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/S0140-6736(15)00473-0","article-title":"Understanding the mechanisms and drivers of antimicrobial resistance","volume":"387","author":"Holmes","year":"2016","journal-title":"Lancet"},{"key":"2026051419581444200_jiag076-B5","first-page":"1107","article-title":"Population-level antimicrobial consumption is associated with decreased antimicrobial susceptibility in Neisseria gonorrhoeae in 24 European countries: an ecological analysis","volume":"221","author":"Kenyon","year":"2020","journal-title":"J Infect Dis"},{"key":"2026051419581444200_jiag076-B6","doi-asserted-by":"crossref","first-page":"329","DOI":"10.3389\/fmed.2018.00329","article-title":"Antimicrobial consumption and susceptibility of Neisseria gonorrhoeae: a global ecological analysis","volume":"5","author":"Kenyon","year":"2018","journal-title":"Front Med (Lausanne)"},{"key":"2026051419581444200_jiag076-B7","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1093\/infdis\/jiz156","article-title":"Deciphering the impact of bystander selection for antibiotic resistance in Neisseria gonorrhoeae","volume":"221","author":"Olesen","year":"2020","journal-title":"J Infect Dis"},{"key":"2026051419581444200_jiag076-B8"},{"key":"2026051419581444200_jiag076-B9","author":"European Committee on Antimicrobial Susceptibility Testing"},{"key":"2026051419581444200_jiag076-B10","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.cmi.2022.02.024","article-title":"How to: ECOFFs-the why, the how, and the don'ts of EUCAST epidemiological cutoff values","volume":"28","author":"Kahlmeter","year":"2022","journal-title":"Clin Microbiol Infect"},{"key":"2026051419581444200_jiag076-B11","doi-asserted-by":"crossref","first-page":"iv16","DOI":"10.1136\/sextrans-2013-051117","article-title":"The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP)\u2014a sentinel approach in the European Union (EU)\/European Economic Area (EEA)","volume":"89","author":"Spiteri","year":"2013","journal-title":"Sex Transm Infect"},{"key":"2026051419581444200_jiag076-B12","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1186\/s12879-019-4631-x","article-title":"Euro-GASP network. The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union\/European Economic Area","volume":"19","author":"Cole","year":"2019","journal-title":"BMC Infect Dis"},{"key":"2026051419581444200_jiag076-B13","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1186\/s12879-017-2707-z","article-title":"Euro-GASP network. Overall low extended-spectrum cephalosporin resistance but high azithromycin resistance in Neisseria gonorrhoeae in 24 European countries, 2015","volume":"17","author":"Cole","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2026051419581444200_jiag076-B14","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1186\/s12879-018-3528-4","article-title":"Euro-GASP network. Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016","volume":"18","author":"Day","year":"2018","journal-title":"BMC Infect Dis"},{"key":"2026051419581444200_jiag076-B15","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1186\/s12879-022-07509-w","article-title":"Euro-GASP network. Significant increase in azithromycin \u201cresistance\u201d and susceptibility to ceftriaxone and cefixime in Neisseria gonorrhoeae isolates in 26 European countries, 2019","volume":"22","author":"Day","year":"2022","journal-title":"BMC Infect Dis"},{"key":"2026051419581444200_jiag076-B16","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1186\/s12879-019-3900-z","article-title":"Ten years of external quality assessment (EQA) of Neisseria gonorrhoeae antimicrobial susceptibility testing in Europe elucidate high reliability of data","volume":"19","author":"Cole","year":"2019","journal-title":"BMC Infect Dis"},{"key":"2026051419581444200_jiag076-B17","doi-asserted-by":"crossref","first-page":"100856","DOI":"10.1016\/j.onehlt.2024.100856","article-title":"The contribution of animal antibiotic use to antibiotic resistance in human infections: panel evidence from Denmark","volume":"19","author":"Emes","year":"2024","journal-title":"One Health"},{"key":"2026051419581444200_jiag076-B18","first-page":"1900112","article-title":"(ESCMID study group for Mycoplasma and Chlamydia infections (ESGMAC) Mycoplasma pneumoniae subgroup; ESCMID Study Group for Mycoplasma and Chlamydia Infections (ESGMAC)). 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